AB1442 OVARIAN PRESERVATION IN JUVENILE SYSTEMIC LUPUS ERYTHEMATOSUS: A MONOCENTRIC COHORT
Authors: S. Costi, D. Chevenne, P. Ellul, V. Baudouin, T. Kwon, R. Caporali, C. Delcou, I. Melki
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Systemic lupus erythematosus (SLE) can impact fertility outcomes and lead to ovarian premature failure. The exact mechanism is not completely understood. Anti-ovarian antibodies have been described as a possible explanation<sup>[1]</sup> but other intrinsic and extrinsic factors are involved. Cyclophosphamide (CYC) is known to have a gonadotoxic effect, but available data are derived from adult cohorts. Anti-müllerian hormone (AMH) is a surrogate biomarker of ovarian reserve in such studies. <h3>Objectives</h3> This study aims to evaluate the ovarian reserve in juvenile-SLE (j-SLE) using AMH and to follow the longitudinal evolution of this biomarker at diagnosis and after the start of treatment. <h3>Methods</h3> Patients with a diagnosis of j-SLE followed at Robert-Debré Hospital, Paris, France, were included. AMH levels were assessed before starting therapy, at 6-10, 12-18, and after 20 months from the start of immunosuppressive therapy. AMH values are expressed in pmol/L with a normal range varying from 7.1 to 51.8, according to pubertal status/age. <h3>Results</h3> 21 j-SLE patients were included (100% female). Patients were divided into 2 groups: i. j-SLE who received cyclophosphamide (48%) and ii. j-SLE who received anti-CD20 treatment (rituximab or obinutuzumab), mycophenolate, or hydroxychloroquine (52%). Clinical and demographical features are summarized in Table 1. 16 patients were menstruating at the initiation of immunosuppressive therapy, while 5 patients were not; however, the first menstrual period occurred between 2 to 4 months after initiation of treatment. The median cumulative dose of CYC was 4.8 grams (IQR 2.2). No statistically significant differences were found comparing pre-treatment AMH levels between the two groups (p= 0.60). The same trend was found evaluating AMH levels at 6-10, 12-18 months, and after 20 months from the start of therapy (p=0.48, p= 0.77, and p= 0.68 respectively). At 20 months the only two patients with AMH values below the normal limits had low values even before starting treatment (0.6 vs 4.9 in group 1 and 1.9 vs 7.4 in group 2 respectively). SLEDAI at the onset of the disease seems to correlate negatively with the values of AMH, nevertheless, the small sample size does not allow to reach statistical significance (S = 1550.9, p= 0.12). In addition, patients with SLEDAI score &gt;20 have lower levels of AMH compared to patients with SLEDAI score ≤20 after 20 months from the start of therapy (p-value = 0.05) (Figure 1), independently of their treatment. <h3>Conclusion</h3> Fertility preservation is a key point in the management of patients with SLE. Our study shows reassuring data regarding the use of CYC in j-SLE and suggests that AMH levels, and consequently ovarian reserve, may be primarily affected by disease severity and activity rather than treatment. <h3>Reference</h3> [1] Hoek, A., Schoemaker, J. &amp; Drexhage, H. A. Premature ovarian failure, and ovarian autoimmunity. <i>Endocr Rev</i><b>18</b>, 107–134 (1997). <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Stefania Costi: None declared, Didier Chevenne: None declared, Pierre Ellul: None declared, Véronique Baudouin: None declared, Theresa Kwon: None declared, Roberto Caporali Speakers bureau: AbbVie, Amgen, BMS, Celltrion, Fresenius, Galapagos, Janssen, Lilly, Novartis, Pfizer, UCB, Consultant of: AbbVie, Fresenius, Galapagos, Lilly, Novartis, Pfizer, UCB, Clémence Delcou: None declared, isabelle melki: None declared.